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Department of
SOCIAL SERVICES

Community Care Licensing


COMPLAINT INVESTIGATION REPORT

Facility Number: 306004761
Report Date: 11/16/2023
Date Signed: 11/16/2023 12:49:29 PM

Unsubstantiated


STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231024084217
FACILITY NAME:CAMBRIDGE COURTFACILITY NUMBER:
306004761
ADMINISTRATOR:LAUREN CHONFACILITY TYPE:
740
ADDRESS:1621 COMMONWEALTH AVENUE, EASTTELEPHONE:
(714) 992-1750
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 80DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Daniela Lopez-Receptionist, Lauren Chon-Executive DirectorTIME COMPLETED:
01:04 PM
ALLEGATION(S):
1
2
3
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8
9
Resident fell due to staff neglect
INVESTIGATION FINDINGS:
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2
3
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5
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9
10
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12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 10/24/23. LPA was greeted and granted entry into the facility and initially met with Receptionist Daniela Lopez. LPA explained the reason for the visit. Executive Director (ED) Lauren Chon arrived shortly after.

This agency has investigated the complaint alleging that resident fell due to staff neglect. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Twelve of thirteen individuals denied the allegation. During interviews conducted with residents it was reported that they have not had a fall due to staff neglect. Per Resident 1 (R1) if she sustains a fall it is because of her Vertigo not because of staff neglect. Per R2 he does not remember a resident laying on the floor for over two hours. During the interviews conducted with staff, Staff 1 (S1) reported that residents have not sustained a fall due to staff neglect and that if residents
CONTINUED ON 9099-C...
Unsubstantiated
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 1 of 4
Control Number 22-AS-20231024084217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
VISIT DATE: 11/16/2023
NARRATIVE
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sustain a fall that residents are not on the floor for long. During the investigation LPA reviewed documents including the Unusual Incident/Injury Reports (UIIRs) dated 10/24/23 for R2 and R3. Per UIIR R2 and R3 had an unwitnessed fall and were taken to the Emergency Room for evaluation. During the course of the interviews ED stated that she is not aware of an alleged fall where the resident was laying on the floor for over two hours. Per ED R2 and R3 did not wait on the floor for long and reported that the highest staff response time could be 30 minutes.

Based on LPA's observation and information gathered during the investigation, LPA is unable to ascertain if the allegation occurred as reported due to conflicting information. Although the allegation may have happened or is valid, there is not a preponderance of the evidence to prove or refute the alleged violation occurred; therefore, the allegation is deemed UNSUBSTANTIATED.

LPA Ramirez conducted an exit interview with ED Chon, and a copy of this report was provided to the facility.

SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 2 of 4
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
This is an official report of an unannounced visit/investigation of a complaint received in our office on
10/24/2023 and conducted by Evaluator Alvaro Ramirez Jr.
PUBLIC
COMPLAINT CONTROL NUMBER: 22-AS-20231024084217

FACILITY NAME:CAMBRIDGE COURTFACILITY NUMBER:
306004761
ADMINISTRATOR:LAUREN CHONFACILITY TYPE:
740
ADDRESS:1621 COMMONWEALTH AVENUE, EASTTELEPHONE:
(714) 992-1750
CITY:FULLERTONSTATE: CAZIP CODE:
92831
CAPACITY:99CENSUS: 80DATE:
11/16/2023
UNANNOUNCEDTIME BEGAN:
09:07 AM
MET WITH:Daniela Lopez-Receptionist, Lauren Chon-Executive DirectorTIME COMPLETED:
01:04 PM
ALLEGATION(S):
1
2
3
4
5
6
7
8
9
Staff are not responding to residents call button in a timely manner
INVESTIGATION FINDINGS:
1
2
3
4
5
6
7
8
9
10
11
12
13
Licensing Program Analyst (LPA) Alvaro Ramirez, Jr. conducted an unannounced complaint visit to deliver findings on the above allegation received on 10/24/23. LPA was greeted and granted entry into the facility and initially met with Receptionist Daniela Lopez. LPA explained the reason for the visit. Executive Director (ED) Lauren Chon arrived shortly after.

This agency has investigated the complaint alleging that staff are not responding to residents call button in a timely manner. LPA Ramirez conducted file reviews and interviews and obtained copies of pertinent documents. Regarding the allegation, the following was revealed: Twelve of thirteen individuals denied the allegation. During the initial visit on 10/31/23 and the visit on 11/16/23 LPA toured the facility and tested the call button in five resident bedrooms. The average staff respond time range from 35 seconds to two minutes and fifteen seconds. During interviews with Resident 1 (R1) it was reported that staff respond to the call button in a timely manner.
CONTINUED ON LIC9099-C...
Unfounded
Estimated Days of Completion:
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
This report must be available at Child Care and Group Home facilities for public review for 3 years.
LIC9099 (FAS) - (06/04)
Page: 3 of 4
Control Number 22-AS-20231024084217
STATE OF CALIFORNIA - HEALTH AND HUMAN SERVICES AGENCY

COMPLAINT INVESTIGATION REPORT (Cont)
CALIFORNIA DEPARTMENT OF SOCIAL SERVICES
COMMUNITY CARE LICENSING DIVISION
ORANGE COUNTY RO, 770 THE CITY DR., SUITE 7100
ORANGE, CA 92868
FACILITY NAME: CAMBRIDGE COURT
FACILITY NUMBER: 306004761
VISIT DATE: 11/16/2023
NARRATIVE
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Per R2 staff respond to the call button within two minutes. During the course of the interviews ED stated that staff respond to the residents' call button in a timely manner and that the goal is to answer the call button within three minutes.

Therefore, the allegation is deemed UNFOUNDED, meaning the allegation is false, could not have happened and/or is without a reasonable basis.



LPA Ramirez conducted an exit interview with ED Chon, and a copy of this report was provided to the facility.
SUPERVISOR'S NAME: Alisa OrtizTELEPHONE: (714) 703-2855
LICENSING EVALUATOR NAME: Alvaro Ramirez Jr.TELEPHONE: 714-703-2840
LICENSING EVALUATOR SIGNATURE:

DATE: 11/16/2023
I acknowledge receipt of this form and understand my licensing appeal rights as explained and received.
FACILITY REPRESENTATIVE SIGNATURE:

DATE: 11/16/2023
LIC9099 (FAS) - (06/04)
Page: 4 of 4